部分脾栓塞术降低肝硬化患者肝静脉压力梯度的初步观察

A study of partial splenic embolization to alleviate hepatic venous pressure gradient in cirrhotic portal hypertension

目的观察研究肝硬化患者脾栓塞的栓塞面积与肝静脉压力梯度(HVPG)降低的关系,探讨脾脏介入栓塞面积对肝硬化患者HVPG的影响,同时观察脾栓塞前后的血细胞及肝功能的变化。方法选取山东大学附属省立医院东院消化内科2010年9月至2014年2月肝硬化失代偿期进行部分脾栓塞术的17例患者进行回顾性分析,以栓塞面积、栓塞前后HVPG变化为主要研究指标,探讨脾脏栓塞面积与患者HVPG降低的线性关系。结果部分脾栓塞术对降低HVPG有显著意义(P<0.05)。脾栓塞的面积与HVPG降低程度具有线性正相关,可拟合Y=0.658X-0.180的直线方程式。根据此方程式,若使HVPG较术前下降20%,得出栓塞面积至少为55%。白细胞及血小板较术前有明显提高。结论部分脾栓塞可显著降低肝硬化门脉高压症患者的HVPG,栓塞面积不小于55%即可有效预防再出血。同时可显著升高白细胞和血小板,有效控制脾功能亢进。部分脾栓塞术术后无严重并发症,为一种安全的治疗方式。

Objective To study the relationship between splenic embolism area and hepatic venous pressure gradient（ HVPG） reducing in patients with liver cirrhosis and evaluate the effect of embolism area on HVPG,and to analyze the changes of blood cells and liver function before and after splenic embolism.Methods Seventeen patients in this study all come from department of gastroenterlolgy,East Clinic of Shandong Provincial Hospital from September 2010 to February 2014. All patients were accepted partial splenic embolization during decompensated cirrhosis phase. The main research indexes were embolization area and HVPG change before and after embolization. The linear relationship between embolization area and HVPG reducing was discussed. Results The effect of partial splenic embolization to reduce HVPG was significant（ P〈0. 05）. And we found the liner relationship between embolization area and HVPGreducing,the equation was Y = 0. 658X-0180. According to the equation,the smallest embolization area was 55% to reduce the HVPG by 20%. White blood cells and platelets increased after embolization. Conclusions Partial splenic embolization can significantly reduce HVPG for patients with portal hypertension. The least embolic area is55% to prevent rebleeding. At the same time,it can significantly improve the levels of white blood cells and platelets,so to treat hypersplenism. All the symptoms can be improved after treatment,without lethal complication. As a result,partial splenic embolization is a safe treatment.